Association Between Timing of Extracorporeal Membrane Oxygenation and Clinical Outcomes in Refractory Cardiogenic Shock

Hyeok Hee Lee, Hyeon Chang Kim, Chul Min Ahn, Seung Jun Lee, Sung Jin Hong, Jeong Hoon Yang, Jung Sun Kim, Byeong Keuk Kim, Young Guk Ko, Donghoon Choi, Hyeon Cheol Gwon, Myeong Ki Hong, Yangsoo Jang

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20 Citations (Scopus)


Objectives: The aim of this study was to investigate whether earlier extracorporeal membrane oxygenation (ECMO) support is associated with improved clinical outcomes in patients with refractory cardiogenic shock (CS). Background: The prognosis of patients with refractory CS receiving ECMO remains poor. However, little is known about the association between the timing of ECMO implantation and clinical outcomes in these patients. Methods: From a multicenter registry, 362 patients with refractory CS who underwent ECMO between January 2014 and December 2018 were identified. Participants were classified into 3 groups according to tertiles of shock-to-ECMO time (early, intermediate, and late ECMO). Inverse probability of treatment weighting was conducted to adjust for baseline differences among the groups, followed by a weighted Cox proportional hazards regression analysis to calculate hazard ratios and 95% confidence intervals for 30-day mortality associated with each ECMO time group. Results: The overall 30-day mortality rate was 40.9%. The risk for 30-day mortality was lower in the early group than in the late group (hazard ratio: 0.53; 95% confidence interval: 0.28 to 0.99). Early ECMO support was also associated with lower risk for in-hospital mortality, ECMO weaning failure, composite of all-cause mortality or rehospitalization for heart failure at 1 year, all-cause mortality at 1 year, and poor neurological outcome at discharge. However, the incidence of adverse events, including stroke, limb ischemia, ECMO-site bleeding, and gastrointestinal bleeding, did not differ significantly among the groups. Conclusions: Earlier ECMO support was associated with improved clinical outcomes in patients with refractory CS.

Original languageEnglish
Pages (from-to)1109-1119
Number of pages11
JournalJACC: Cardiovascular Interventions
Issue number10
Publication statusPublished - 2021 May 24

Bibliographical note

Funding Information:
This work was supported by the Korea Health Technology Research & Development Project (grants HI17C0882, HI16C2211, and HI15C2782) through the Korea Health Industry Development Institute, funded by the Ministry of Health and Welfare, Republic of Korea; the Bio & Medical Technology Development Program of the National Research Foundation, funded by the Korean government (grant 2015M3A9C6031514); and the Cardiovascular Research Center (Seoul, Republic of Korea). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publisher Copyright:
© 2021 American College of Cardiology Foundation

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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